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Peri-orificial Dermatitis

Maladywise

Overview

  • Multiple, small, red, inflammatory spots around holes (peri = around, orifice = hole)

  • Includes the mouth (perioral), nose (perinasal), eyes (periorbital) and genitals (genital POD) 

  • It classically resembles a rash that is somewhere between acne, rosacea and dermatitis. 

  • The cause is not well understood.

  • Most common in lighter-skinned women aged 20 to 45 years, also seen in young children.

Fact Sheet:

Reference:

Risk Factors

  • Corticosteroid use via all routes (topical cream, inhalers for asthma, nasal for hayfever)

  • Cosmetic use

  • Skin dysfunction due to

    • Nutritional deficiencies e.g. zinc deficiency

    • Occlusive emollients leading to overhydration e.g. paraffin or petroleum-based emollients

    • Sunscreen, particularly in children

  • Allergic / irritants e.g. toothpaste, dental fillings

  • Infections 

    • Demodex mites in hair follicles

    • Fungal infections like Candida

    • Fusiform Bacteria

  • Hormonal changes caused by oral contraception, pregnancy, premenstrual

  • History of atopy (allergies, asthma, hayfever)

  • Physical factors seem to worsen symptoms

    • UV light

    • Heat

    • Wind

Symptoms

  • Acne type eruption

  • Clusters of skin-coloured or red bumps, vesicles or pustules

  • Can coalesce together

  • Scaly and flaky skin

  • Burning or sensation or skin tightness

  • Itch

  • Usually only around one orifice (mouth, eyes, nostrils)

  • Can spread to the chin, cheek, outside eyelids, and forehead

  • Skin immediately surrounding lips often spared

Management

  • Stop any topical corticosteroids

    • For example - Hydrocortisone, Celestone, Disprosone, Advantan

    • These classically trigger POD and often provide short-term improvement followed by a rebound worsening effect once ceased.

    • Strong doses can be weaned down over days to weeks

  • Medically necessary nasal, inhaled or oral corticosteroids should be continued but may delay recovery.

    • Rinsing the mouth and face after use can help

  • Avoid any topical products that promote or exacerbate POD

    • Referred to as “Zero therapy”

    • Typically involves gentle skin cleansing with a fragrant-free, non-soap cleanser promptly followed by complete and gentle rinsing of the skin

    • Limiting the use of everything else if possible

      • Cosmetics

      • Sunscreens

        • If needed, a gel or liquid sunscreen can be used

      • Moisturisers

        • Occasional “only as needed” application of a bland, non-occlusive moisturiser

      • Perfume 

    • Once the rash resolves, slowly reintroduce products (e.g. one product per week) and monitor response. Cease any product that induces recurrence.

Mild Disease (relatively small area, no significant emotional distress)

  • Zero Therapy

  • Topical Therapy twice daily for 4 to 8 weeks if needed

    • Elidel (Pimecrolimus) 1% cream 

    • Metronidazole 0.75% or 1% lotion, gel or cream

    • Erythromycin 1% or 2% gel 

    • May not be tolerated due to facial sensitivity

Moderate Disease (larger areas, emotional distress, failed topical therapy)

  • Oral Antibiotics

    • Doxycycline 50 to 100mg twice daily or 100mg once daily

    • Erythromycin 500mg twice daily

    • Generally treated for 4 to 8 weeks

    • Can be effective in small bursts of 1 to 2 weeks